Otolaryngology Coding Alert

Question: If the otolaryngologist performs a petrous apicectomy of the left ear that includes radical mastoidectomy, and then proceeds to perform a complete mastoidectomy on the right ear, can I report both services?

Colorado Subscriber

Answer: You’ll encounter a National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit with a modifier indicator of “1” when comparing the two codes in question, 69530 (Petrous apicectomy including radical mastoidectomy) and 69502 (Mastoidectomy; complete). The edit allows you to unbundle 69502 from 69530 under the appropriate circumstances. Unless guidelines suggest otherwise, one of these circumstances includes scenarios where services are performed on contralateral anatomic sites. In fact, the NCCI Policy Manual makes reference to this exact code pairing in Chapter 8:

• “If the code descriptor for a procedure of the auditory system includes a mastoidectomy (e.g., CPT^® codes 69530, 69910), an additional code describing a mastoidectomy (e.g., 69502-69511) is not separately reportable for the ipsilateral mastoid.”

So long as you’re aware that ipsilateral means same-side of the body, you can use this as confirmation that it’s appropriate to bill these services together. Furthermore, the only unbundling modifiers required in this example are the LT (Left Side) and RT (Right Side) modifiers appended to 69530 and 69502, respectively